An Effort to Expand Access to a Drug That Could Save Victims of Overdoses

Kelly O’Neill of Nassau County, whose son died of an overdose. “I wish I’d known about this beforehand,” she said of naloxone.Credit
Hiroko Masuike/The New York Times

Samantha Dittmeier was the youngest of Karen Allar’s four children. “She was very loving, very compassionate,” said Ms. Allar, 51, an employment counselor who lives on Long Island. “Unfortunately, the addiction got to her.”

Ms. Dittmeier, 23, died of a heroin overdose in January, leaving behind her 3-year-old son, Aiden. Ms. Allar is haunted, she said, not just by her daughter’s tumble into addiction, but also by the circumstances of her death. She wonders if her life might have been saved if the emergency workers who treated her had been armed with naloxone, a powerful drug that can reverse the effects of an overdose.

“You start to get that sick feeling again,” Ms. Allar said, recounting a frantic race to the hospital just before Ms. Dittmeier’s death. “I’m back at work. I’m trying to think positive about such a horrible situation.”

On Long Island and across New York State, drug overdoses are taking an increasing toll. The most common killers are opioids, a class of painkillers that includes prescription drugs like Vicodin, OxyContin and Percocet, as well as illegal narcotics like heroin.

In Suffolk and Nassau Counties, the two that make up Long Island, 338 people died of opioid overdoses in 2012, up from 275 in 2008, according to county records. Statewide, opioid overdoses killed 2,051 people in 2011, more than twice the number that they killed in 2004.

The spate of deaths is spurred, in part, by the easy access to prescription drugs. As a result, the state has begun several efforts to stem access to prescription drugs. A new law aims to stop addicts from gaining access to multiple rounds of medication by requiring doctors to consult an Internet database that tracks prescriptions.

Some public health experts and antidrug advocates, however, are offering another way to prevent overdose deaths: naloxone, an easy-to-administer, inexpensive drug that is sprayed into the nose or injected into the body. The more people who carry it, they say, the better.

The Food and Drug Administration approved the drug to treat overdoses in 1971, and since then it has been widely used in hospitals. Now, it is slowly getting into the hands of nonmedical personnel across New York State.

“I wish I’d known about this beforehand,” said Kelly O’Neill, 46, of Nassau County, whose son Billy died of a heroin overdose in 2011 at age 25. “It’s kind of like, ‘Thank God it’s here,’ but it’s taken so long for them to get it here.”

Opioids function in the body by attaching to specific proteins, called opioid receptors. When opioids attach, the body relaxes and breathing slows. But too much of an opioid can cause respiration to slow to a lethal level.

Naloxone acts by competing with opioids for the receptor sites, essentially pushing the opioids out of the way and reversing the effects of the drugs.

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The timing is critical. Depending on the dosage taken and the conditions of a user, a person can die within minutes of taking an opioid, so naloxone must be administered quickly. The drug is used not just to save substance users, but also children who accidentally wander into a parent’s medicine cabinet.

Until recently, though, the only emergency personnel in New York trained to use naloxone were the state’s 7,500 paramedics, who have advanced training but are often not the first to arrive at the scene of an overdose.

Now, a pilot program in Suffolk, Nassau and four other New York regions is training emergency medical technicians — who have less training but are more likely to be the first to reach an overdose victim — how to use naloxone. There are 42,000 E.M.T.’s in New York, many of them also police officers and firefighters. The two-year pilot program is scheduled to end in 2014, when the State Department of Health will decide if all state E.M.T.’s should be trained. Since spring 2012, newly trained E.M.T.’s have administered naloxone to 197 people who overdosed.

A second statewide effort is aimed at getting naloxone into the hands of people without medical training, an effort spurred by a 2006 New York law that made it legal for community organizations and health departments to deliver naloxone training. Similar laws exist in at least a dozen cities and states, including New Jersey and Connecticut. People who might seek training could include parents of addicts or a volunteer who works with substance abusers.

A list of organizations that provide naloxone training is available on the State Health Department’s Web site. The training takes 10 minutes to one hour, and graduates are given small blue bags containing two doses of the drug.

The recent addition of a nasal version of naloxone has made it easier for people without medical backgrounds to administer the drug. Still, some people caution against its widespread distribution.

Paul A. Werfel, who oversees the E.M.T. and paramedic training program at Stony Brook University on Long Island, said drug users can become combative after they are given naloxone. “The average E.M.T. in Suffolk may not necessarily have the tools to handle that,” he said.

Others, however, say that the drug’s lifesaving potential outweighs such concerns. A growing body of research about the drug’s effectiveness has turned many skeptics into advocates, said Dr. Sharon Stancliff, the medical director at the Harm Reduction Coalition, a national nonprofit group.

A study published in the Annals of Internal Medicine in 2012 found that one life could be saved for every 227 naloxone kits distributed to heroin users and those close to them.

A version of this article appears in print on August 22, 2013, on Page A23 of the New York edition with the headline: An Effort to Expand Access to a Drug
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